ICSI has revolutionised the treatment of male infertility, offering assistance to couples who previously were unable to have a baby whose father was the genetic parent.
With ICSI, very few sperm are required and the ability of the sperm to penetrate the egg is no longer important as this penetration is bypassed by the ICSI technique. This has changed the course of the treatment of male infertility, helping up to 95% of couples to reach embryo transfer who previously had only donor sperm or adoption to choose from. It is important to remember that whilst ICSI is a technique used in the laboratory to help fertilisation occur, it does not guarantee it. From the female perspective this technique is the same as IVF treatment, the only difference being the laboratory process used to fertilise the egg.
Our Centre was one of the first NHS units in the UK to be licensed to offer this treatment and has since carried out several thousand ICSI cycles with consistently good fertilsation and pregnancy rates. For couples requiring ICSI the treatment pathway is identical to that of IVF, except for the method of insemination. For ICSI, the sperm is injected directly into the prepared egg, rather than simply mixed with the eggs in a dish.
Specialist equipment is used to enable our embryologists to manipulate the eggs and sperm under the control of high-powered microscopes, performing very precise surgical procedures on a microscopically small scale. Tiny glass instruments are prepared in the laboratory which hold the eggs in place (micropipettes) and enable sperm to be injected through the outer layers of the egg (microneedles), past the shell of the egg (zona pellucida) and into the main body of the egg (cytoplasm).
The couples go through the same preparatory processes as IVF, namely ovulation induction and egg collection. The difference is how the embryologist deals with the eggs and sperm in the laboratory.
ICSI is used in the following circumstances:
Only eggs from large follicles that sufficiently mature can be injected by ICSI. It must be noted that the process of injecting a fine pipette into the egg can result in damage to the egg which means that approximately 85% of the eggs injected survive. ICSI does not guarantee fertilisation but, on average, we expect that 60-70% of injected eggs will fertilise. ICSI is at least as successful as standard IVF.
ICSI cannot be performed if there is no sperm being produced by the testes which is, however, extremely rare.
According to the HFEA regulations, if no fertilisation occurs following routine IVF insemination, those eggs cannot then undergo ICSI in the same cycle.
Piercing the egg with the injection needle, during the ICSI procedure, may occasionally cause some damage. This damage will be evident either during or immediately after the procedure and will result in that particular egg not being transferred, thus eliminating the possibility of any abnormalities.
There is a link with the gene mutation which causes cystic fibrosis and very severe male infertility. We recommend that all patients with an extremely low sperm count are tested to determine whether or not they carry this mutation.
Current research information tells us that there is no increased risk of congenital abnormalities in children conceived through ICSI. However, some forms of severe male infertility do have a genetic link and it is possible that fathers may pass on their sub-fertility to their sons. This means that these children may also require infertility treatment to become parents.
Please also see our patient information booklet for further information
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